[libribook.com] Traumatic Scar Tissue Management 1st Edition

According to Klingler (2012):
… painful contractures resulting in limited/reduced range of motion are often associated with
rigid collagenous tissue within and surrounding skeletal muscle, as well as other CTs involved
in force transmission (e.g. retinaculae, thoracolumbar fascia, tendon).
Hypertrophic
scar
Keloid scar
Atrophic scar
Widespread
scar
An elevated, excessive scar that is limited to the original boundaries of the incision or wound
(Bordoni & Zanier 2014, Zhu et al. 2013). Common features include raised, thickened, red and
sometimes ropelike scarring. Hypertrophic scars can lead to deformity, disfigurement and loss of
function and can take weeks to form. Scars formed at the fringe of skin grafts are prone to
hypertrophy (e.g. those associated with deep second-degree burns and other scars requiring grafts).
Both hypertrophic and keloid scars occur more commonly in the regions of the anterior chest,
shoulder/periscapular, lower abdomen and ear lobes (Ogawa 2008, Bordoni & Zanier 2014) (see
Fig. 5.1)
An abnormal scar that forms at the site of an injury or an incision and spreads beyond the borders
of the original lesion. The scar is made up of a swirling mass of collagen fibers and fibroblasts.
Keloid scars reach out like little fingers and extend well beyond the original injured area. Common
features include thickened, raised, itchy clusters of scar tissue that grow beyond the edges of the
wound or incision and are often red or darker in color than surrounding skin. Keloids occur when
the body continues to produce the tough, fibrous collagen after a wound has healed. Keloids most
commonly appear over the sternum, ears and shoulders and occur more in dark-skinned people.
The tendency to develop keloid scars lessons with age. Some scars may start as hypertrophic and
eventually develop into keloid (see Fig. 5.2)
Common presentation is a fibrotic, cutaneous depression displaying a sunken or pitted appearance
(Weiss et al. 2010)
Can appear when the fine lines of surgical scars gradually become stretched and widened. These
typically flat, pale, soft, symptomless scars are more common following knee or shoulder surgery
(Rudolph 1987). Stretch marks (abdominal striae) are variants of widespread scars involving injury
to the dermis and subcutaneous tissues without breaching the epidermis. There is no elevation,
thickening, or nodularity in mature widespread scars, which distinguishes them from hypertrophic
scars (Bayat et al. 2003)